“Turn This Way”

A few days ago I received an unexpected email from a professional colleague at the University of Alabama in Birmingham (UAB), informing me of the death of Dr. Hugh M. Shingleton. Dr. Shingleton’s pedigree is unchallenged in the world of academic gynecologic oncology. He was from a small town in North Carolina and rose to the heights of the profession. In fact he helped define the discipline. He was the first gynecologic oncologist in the state of Alabama and helped set the standard of care for women with gynecologic malignancies in the South, the nation and internationally during his many decades as a professor at UAB. Go to PubMed or Google his name and you’ll see what I mean.

His death caused me to toss and turn in bed for several nights as I reflected upon what his life had meant to me.

After finishing Oberlin College in 1970 and moving around the country for several years, ‘trying to find myself’, I returned home to Birmingham (Fairfield), Alabama. After getting shot in the neck while helping to lead a worker’s strike at one of Birmingham’s local iron factories, it dawned on me that I needed to find a less riskier way of pursuing Oberlin College’s mantra: “One person can change the world.” Through a very circuitous route I ended up in the Electron Microscopy Research Lab of Dr. Shingleton at UAB as a work-study student. One day while I was washing glassware he stopped by, stuck his head in the door, and said to me: “I’m on the way to the operating room, would you like to join me?” I jumped at the chance and together we walked upstairs to the OR. He showed me how to put on a scrub suit and told me to go into the theatre as he scrubbed his hands in preparation for surgery. He was tall and lanky and had big feet. I stood in the corner and watched his every move as he literally waltzed into the room with water dripping down his arms, dried his hands, gracefully slipped into his gown, put on his latex gloves, and almost danced as he turned and tied the strings of his gown while slowly moving up to the table where the patient was located. Although he was a consummate cancer surgeon he was just as good at repairing defects in the female pelvis associated with weak pelvic ligaments. That day he was performing a very complicated case and was operating through the vagina. At the time I had no clue of what he was doing but I watched very attentively as he reconstructed a very distorted pelvis back to its normal anatomical state. What impressed me most was his style. He had very long and nimble fingers that seemed to move with the rhythm and delicate touch of a ballerina’s feet on the dance floor. At the end of the case he took off his gown and exited the room as gracefully as he had entered. It was at that very moment that I said to myself: “I don’t know what this is that I just saw, but whatever it is I want to be it.” Some months later I told him I wanted to go to medical school to which he replied: “Well, if you think you got it then go ahead. I’ll back you.” He wrote a great letter of recommendation for me and I was accepted into UAB’s Medical School Class of 1981. Each summer, during medical school, I worked in his lab. Each time he gave me more responsibility. On occasion he would take me with him to academic meetings in other parts of the country. It was on one of these trips that I met some of the leading academic surgeons in the fields of Urogynecology and Gynecologic Oncology. During the summer before my senior year of medical school he guided me through a chart review of patients who had undergone radical surgery at UAB for cancer of the cervix. He gave me a deadline and every day and every night I combed through the details of over 400 patient charts, extracting data on urological complications. Sometimes I’d go in at 8:00 a.m. and wouldn’t leave until 4:00 a.m. the next morning. I did it by hand for this was before the days of electronic databases, PC’s etc. Page by page I went through every chart and recorded my findings. At the end of the project he asked me to write up my findings in the form of an academic abstract. I did and when I presented it to him, handwritten, he said: “This is better than what 80% of the doctors on my staff could have done.” The full manuscript was eventually published in the academic journalGynecologic Oncology under the citation: Ureteral strictures and fistulae following radical hysterectomy. Hatch KD, Parham G,Shingleton HM, Orr JW Jr, Austin JM Jr. Gynecol Oncol. 1984 Sep;19(1):17-23.

It was during my senior year in medical school that he took me to an American Urological Society meeting in New Orleans to present my findings. This was my very first presentation before an audience of academic physicians. Prior to the presentation he made me practice several times before him and other doctors in the department of OB/Gyn at UAB. What he didn’t do was prepare me for the questions and answers that would follow the presentation (maybe by design) and I was literally creamed by the audience. The only time I felt worse was when I became nervous and forgot the lines to my Easter Sunday speech in church when I was 8 years old. At one point during the Q and A session Dr. Shingleton stood up and said: “I want to remind all of you in this room that the person presenting this talk is only a senior in medical school”, after which they backed off a bit. Upon returning to my seat in the audience an old white-haired gentleman walked up, touched me on the shoulder, and said: “Young man you got lots of balls to stand up before a group like this and present an academic paper as a med student.” I looked over at Dr. Shingleton, he smiled and winked his eye. Later that night he took me to dinner at a 5 star restaurant with doctors from across the globe. I watched how he ordered food, how he went about choosing a fine wine from Chile, how he engaged in intellectual interchange, the manner in which he cut and ate his steak, etc. On the way back to the hotel, as we walked along Bourbon Street, he talked about marriage, raising children and the perils, stresses and challenges of success. He said something to me that has played over and over in my mind at least a million times: “I’m from poor white southern trash, but you have to remember Groesbeck, your background does not have to determine where you end up in life.” He also cautioned me that I would have to be careful as a successful man not to make life too easy for my children. “You don’t want them to confront your same struggles but you can’t make it too easy for them. It’s a very, very difficult balance. You’ll see.” During the dinner he introduced me to one of the world’s premier urogynecologist and asked if I would like to go to London, England to train in this individual’s unit. I thought he was just boasting and bragging but I jumped at the opportunity and said, “Yes.” After completing medical school I became an intern and resident physician in the Department of Obstetrics and Gynecology at UAB, one of the best training programs in the nation. At the time I was the first African American to be accepted in that position (1981). Dr. Shingleton supported my application. He also supported my quest to become a gynecologic oncology fellow at the University of California, Irvine, also one of the top tier training programs in the world, in which I also happened to be the first African American trainee. However, before starting my fellowship at Irvine I had a year to burn, so I went back to Dr. Shingleton and reminded him of the offer he had made for me to go to London to study urogynecology. He stuck to his word and appointed me as Assistant Research Professor in the Department of Obstetrics and Gynecology at UAB in 1985. This allowed him to use departmental funds to provide financial support for my family and me during the year I lived and studied in London. It kept me afloat until I could get medical license in England, after which I could moonlight as a surgical assistant on weekends. My kids went to public schools in London during that year. We traveled all over Western Europe on long weekends and holidays. We visited many of the great museums and Opera houses. By far it was the best year we have ever had together, as a family. It changed all of our lives. It was during my time in London that I heard of the great African pelvic fistula surgeon, Dr. Abbo Hassan Abbo. Dr. Abbo had a world-renowned female pelvic fistula hospital in Khartoum, Sudan that repaired pelvic defects caused by female genital mutilation (circumcision). He was a friend with the surgeon under whom I was studying in London. I telexed him, told him I wanted to come to Sudan and work with him, he said OK, and 8 months into my studies in London I took my family and we flew to Khartoum where I studied under Dr. Abbo for four months in 1986, my first trip to Africa (read the upcoming book for this part of the story).

After I the completion of my gynecologic oncology fellowship Dr. Shingleton and I stayed in contact through letters, his annual Christmas messages and a few phone calls. As I began traveling and working throughout the world he would send me postal cards asking, “what planet are you on now?” I channeled his enthusiasm for solving the riddle of cervical cancer screening directly into the deepest deposits of my intellect. He exposed me to international medicine. The necessity of hosting important and influential people on ones home turf, to show them your work, was something I learned from him. “We have to show people that just because we are from the Deep South does not mean we are all dumb red-neck country bumpkins” was his answer to my question of “why are you always bringing all these people from around the world to Alabama?” I have translated that message to my team of African professionals by saying: “Just because we live and work in Africa does not mean we can’t produce something that is first class.” His wife Lucy was one of the kindest human beings I have ever met in my life. Quiet, graceful, steady, sturdy, genuine and never judgmental, she was very kind to me and my wife and children during some very difficult times.

Reflections

As I move around the world I often encounter African American and African students who are trying to find their way through the morass. They commonly say to me: “What I need is an African American or African mentor but they are few and far in between.” My response is always this: Mentorship has nothing to do with race, gender, nationality or socioeconomic class, and you may miss your mentor if you look for him or her in a particular package. Your mentor is the person who is there, standing in the fork in your road, showing you the way. You simply have to recognize their presence. Could be the janitor or the maid. The librarian. The homeless woman who is begging on the street for a cup of coffee. The commercial sex worker. The preacher. Your mother or father. The gay guy next door or the lesbian at work. Your drunk uncle. The funny lookin’ chain smokin’ dude at AA meetings. The person who originally rebuked you, or who you thought rebuked you, or whose race or clan or tribe rebuked your race or clan or tribe. Often times the invitation is oh so slight. It’s up to you to recognize him/her and to have the guts and tenacity to believe as much in yourself as they believe in you.” Dr. Shingleton, “The Shing” as we fondly referred to him, was that for me. A man who originated from “poor white southern trash” but who was standing in the fork in my road and said “Turn this Way.”

During his latter years, when he was deep into retirement, he expressed a longing desire to have his decades of service at UAB recognized in some form or the other. A plaque or picture on the wall. Some type of special ceremony. Something that said he had been there and that chronicled what he had accomplished. He asked if I could help. My response was this: “Dr. Shingleton, your greatness is in the people that you trained and their accomplishments. The women with cervical cancer whose lives were saved because of the knowledge and wisdom you passed along. The leaders you trained who are now leading, all over the world. Public notoriety pales in comparison.” He wrote back and said: “You were always wiser than me, in this aspect of life.” I continued to write, informing him of my experiences, always expressing my deep gratitude. At some point he stopped responding. I assumed time had lifted him into another space, which was fine. By default the last path he revealed to me was the one that had the following sign written on it: “I’m good enough, just as I am.”